The accountability problem of the National Institute for Health and Clinical Excellence.

The paper is a reflection on some of the ethical issues relating to decisions on the availability of new drugs made by the British National Institute for Health and Clinical Excellence (NICE). It outlines the way in which the Institute and its advisory committees make decisions on the funding of new treatments by the National Health Service and discusses the proposition that the organisational structures and methods of the Institute give rise to an accountability problem. It is suggested that NICE should simplify the way decisions are made, take proactive steps to better inform the public about the advantages and limitations of its approach, and provide a clearer distinction between the Institute itself and the appeal panels, which consider objections to its decisions.